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- Woman with acute renal failure
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| 姓 名： | ××× | 性别： | female | 年龄： | 35 |
| 标本名称： | Kidney needle biopsy | ||||
| 简要病史： | Patient had history of scleroderma for years and hypertension crisis last month. | ||||
| 肉眼检查： | |||||
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本帖最后由 于 2009-07-16 21:58:00 编辑
×参考诊断
| 以下是引用geng72在2009-7-22 10:04:00的发言： 本例患者电镜可见内皮细胞增生、肿胀，肿胀的内皮细胞与基底膜剥离，形成透亮区，光镜下肾动脉内膜增厚，狭窄，有纤维素样坏死及血栓形成，肾小球内皮细胞增生，肿胀，内皮增厚，首先考虑是血栓性微血管病，如果患者有恶性高血压，考虑是由于恶性高血压引起的继发性TMA，当然，硬皮病等自身免疫性疾病，也可以引起TMA，需要结合临床考虑。 |
The above is a very nice description/comment. This patient has history of scleroderma and then developed hypertension crisis.
Thrombotic microangiopathy includes the many conditions which affect small vessels. But they are morphologically overlaping or sometimes identical in kidney biopsies. The following is the predominant changes of major TMAs.
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Hemolytic uremic sundrome (HUS) |
Bloodless glomeruli, arteriolar fibrinoid necrosis, arterial intimal edema, thrombosis |
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Thrombotic thrombocytopenic purpura (TTP) |
Platelet-rich thrombi. |
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Disseminated intravascular coagulation (DIC) |
Fibrin-rich thrombi. |
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Antiphospholipid antibody syndrome |
Thrombosis in veins, arteries, arterioles, and glomerular subendothelila expansion (bloodless) and GBM remodeling. |
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Preeclampsia/eclampsia |
Glomerular capillary endothelial swelling (endotheliosis) |
